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Organization
POSITIVE LIFE CHANGES
Active
Organization
POSITIVE LIFE CHANGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA MIDGETTE (PRESIDENT/PROGRAM SUPERVISOR)
(252) 557-0444
Entity
Organization
Contact information
Practice address
210 E MAIN ST, HOOKERTON, NC 28538-0000
(252) 557-0444
(252) 557-0445
Mailing address
210 E MAIN ST, HOOKERTON, NC 28538-0000
(252) 557-0444
(252) 557-0445
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6112264
—
NC
Enumeration date
02/25/2010
Last updated
10/18/2018
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